Chronic Anal Fissure - A Prospective Study

Abstract

Back Ground: Chronic anal fissure is one of common anal condition of world population. Conservative management is initially recommended with ointments and analgesics. When conservative measures fail despite of recommended length of therapy, surgical option is offered to the affecters. Lateral sphincterotomy is a surgical option recommended and accepted worldwide. The pre amble of the study was to assess lateral sphincterotomy in terms of safety and final outcome for the surgical management of chronic anal fissure. Patients and Methods: 120 diagnosed cases of chronic anal fissure admitted during 1 st July 2012 to 30 th June 2014 in the Department of surgery in Dhiraj Hospital ,SBKS MI&RC affiliated to Sumandeep Vidhyapeeth University, Pipariya, Vadodara, Gujarat were included in study. Patients with anal fissure with other peri-anal conditions, recurrent anal fissure, hepatitis positive, and childrens were excluded from the study. The data was recorded and analyzed. Post-operative follow-up was maintained every two weeks for six visits (12-weeks). Any complication was recorded on history and physical examination. Results: Out of 120 diagnosed cases of anal fissure, common age group was 31-40 years (49%) and most of the patients were females with male to female ratio of 1:1.7. Pain (100%) was the commonest symptom followed by constipation (82%). 79% had posterior fissure, while 20% patients had anterior fissure, while 1% patient had anterior as well as posterior fissure. The mean duration of post-operative hospital stay was 3 days. All patients turned up for first follow up visit at 2 nd week and no complaints were filed except flatus incontinence by only 2% cases. Total 33% patients were lost during follow up while only 3% patients complained flatus incontinence on 6 th and 12 th week follow up. No recurrence or faecal incontinence was reported by any patient. Conclusion: Lateral sphincterotomy is safe and effective surgical management for chronic anal fissure with minimal postoperative complications.